Wandering and sundowning: what they are, how to lower the risk, and what to do the day it happens

Wandering, in plain words

Wandering is when someone with dementia walks or drives away and cannot find their way back. It can happen on foot from the house, from a store, or from a car. The Alzheimer's Association says six in ten people living with dementia will wander at least once, and many do so repeatedly. It is not stubbornness; the person is usually looking for something that makes sense to them, like going home or going to work.

Warning signs

• Coming back from a walk or drive later than usual.
• Forgetting the way to familiar places.
• Saying they want to go home while at home, or asking about people from long ago.
• Pacing, restlessness, or trying to leave at the same time each day.
• Trouble finding the bathroom or bedroom.
• Getting anxious in crowds or in a new place.

Lowering the risk

No home is wander-proof, but these changes help most families.

• Give the day a shape: meals, a walk, a chore, and rest at the same times. Boredom and unmet needs, like hunger or a full bladder, are common triggers.
• Notice the time of day it happens and plan something calming for that hour.
• Put deadbolts high or low on exit doors, out of the usual line of sight. Try a bell or a door chime, or a pressure mat by the door.
• Keep keys, coats, and purses out of sight; they are cues to leave.
• Have the person wear an ID bracelet or carry ID, and keep a recent photo on your phone. MedicAlert has a program with the Alzheimer's Association for wandering.
• Tell the neighbors, and give the local police a heads-up in a small town.
• Do not leave someone who has wandered alone in the house or the car.

If someone is missing

• Search the immediate area first: the yard, the block, the usual walk, places tied to a past routine. Many people are found within a mile and a half of where they left.
• If you have not found them within 15 minutes, call 911. Say the person has dementia. You do not have to wait 24 hours.
• Have the photo, a description of clothing, any medical conditions, and the car description ready.
• In New York, police can issue a Missing Vulnerable Adult Alert for an adult with a cognitive condition who is at risk. It goes to other agencies, highway signs, and the media for up to 72 hours. Ask the officer about it.

Sundowning

Sundowning is increased confusion, restlessness, or agitation from late afternoon into the night. Nobody knows exactly why it happens; tiredness, a disrupted body clock, low light and shadows, and the day's stress all seem to play a part. It tends to appear in the middle stage.

What tends to help in the evening

• Schedule the demanding things, like showers and appointments, for the morning.
• Get daylight during the day and keep rooms well lit as evening comes; close curtains before it is dark outside.
• Turn down stimulation after dinner: television off, fewer visitors, no big chores.
• Play familiar music or a favorite old show. Offer a simple task, like folding towels.
• Limit naps, caffeine, and alcohol, and keep dinner on the lighter side.
• If evenings suddenly get worse, tell the doctor. Pain, an infection, constipation, or a medicine change can look like sundowning.

Take care of the nights

If you are up every night, you will not be able to keep going. Ask about an overnight aide, a night at respite, or a sleep plan from the doctor. Nights that are no longer safe are one of the most common reasons families look at memory care, and that is not a failure.